The authors assert that mental-health therapy over video platforms "has been demonstrated as clinically equivalent to in-person care."
Before the pandemic, they write, video-to-home telehealth services for mental-health care was not uniformly offered, but has since gained some traction, especially in rural areas where mental-health provider shortages are great.
The authors note that telehealth visits have ensured continuity of care during stay-at-home orders, all while minimizing physical contact to keep both patients and providers safe.
But they also recognize that this type of care also comes with many challenges, including overburdened networks, poor internet bandwidth, inconsistent internet service, a lack of equipment, billing and scheduling challenges, and usability issues for both providers and patients. These challenges have resulted in some providers conducting phone-only visits, especially after federal rules were relaxed to allow reimbursement for such visits.
But the authors say that in this time where "the loss of in-person contacts has never been more pronounced," phone-call appointments, while efficient, don't offer the same connection that video-based meetings do.
"During this pandemic, we believe that visual contact remains crucial; thus institutions that work to facilitate the availability of [video-to-home] visits will significantly benefit both patients and providers," they write. "Robust telehealth programs require a significant commitment of time and resources, and large health care organizations with the foresight to invest in telehealth are poised to transition [mental health] care from in-person to virtual visits."
The authors say they regularly collect patient input through interviews about virtual appointments, and have found that many patients say the video connection makes it more personal and that seeing their provider during the therapy session is "very important." Further, patients have told them that they are more comfortable getting their mental-health care at home.
"We believe that prioritizing video over phone-only calls will help maintain the integrity of [mental health] care by maintaining important social rhythms, supporting rapport, and offering a more patient-centered care approach," they write.
They add that such visits allow for the re-establishment of "social rhythms" that many patients prefer, and let the patient and the provider see nonverbal communication cues that would otherwise be missed. It also allows the provider a window into their patient's physical space, the authors write.
Video-to-home "may help patients share more with their provider within the context of therapy by enhancing the therapeutic relationship and allowing providers to establish connections that could never be achieved over the phone," they write.
The authors conclude that video-to-home "will become part of the new normal in the post-pandemic period" and say that now is the time to build competency and capacity for it.
In particular, they note that video-to-home care has been quite successful in rural Veterans Health Administration treatment centers.
A study, also published in The Journal of Rural Health and named article of the year, found that over a six-year period, 2009 to 2015, use of clinical video telemedicine grew from 30 to 124 encounters per 1,000 veterans, with faster growth among rural veterans than urban ones. It also found that more than 50 percent of the telehealth visits were for mental-health care.
The study adds that in fiscal year 2015, the last year of the study, 3.2% of urban and 7.2% of rural veterans used telemedicine for nearly 725,000 clinical encounters.
The authors said vets were more likely to use telemedicine if they had a "younger age, longer driving distance to VHA facilities," or multiple medical conditions.
The study concludes that the availability of telemedicine "has likely increased access to care for rural veterans, especially for mental-health care."
The challenge of broadband access that is needed to facilitate telemedicine is not just a problem for rural America, but also in tribal nations.
A letter to the editor in the same journal speaks of barriers to health care among tribal nations in the Southwest: "It is likely that the covid-19 pandemic will exacerbate disparities among American Indian tribes, particularly when coupled with existing barriers to access health services."
The authors point to commentary that provides a history of the many challenges Native Americans have had with infectious diseases, as well as those that currently exist amidst the covid-19 pandemic, and points to telemedicine as a way to address this.
But they note the ongoing challenges that exist around broadband internet services, and summarize the Census Bureau's American Community Survey 2018 estimates for census tracts with the largest tribe in the U.S.: "58.1% to 87.7% of households in Navajo Nation census tracts reported not having broadband internet services, compared to 19.6% nationally." Even if Native Americans have internet access, these locations are not ideal for telehealth visits, especially if related to mental health, they write.